Toshima Y, Kohno H, Matsuzaki K, Mitani A, Mayumi H, Yasui H, Tokunaga K
Division of Cardiovascular Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Thorac Cardiovasc Surg. 1992 Dec;104(6):1572-81.
The following hypotheses were tested using an isolated perfused working rat heart model: (1) Collins' solution for cold storage of the heart is harmful for the heart during reperfusion; (2) a "reverse" of the intracellular-type Collins' solution with an extracellular-type cardioplegic solution before reperfusion is able to prevent this disadvantage of Collins' solution. The following two major groups (I and II) and five subgroups (-a to -e) in each group were prepared. In group I (reversed group); the hearts were initially stored in Collins' solution but were reversed by a 1-minute flush with cardioplegic solution followed by storage in cardioplegic solution for the last 1 to 180 minutes of the total 3-hour storage, that is, groups I-a (reversed for 1 minute), I-b (10 minutes), I-c (30 minutes), I-d (90 minutes), and I-e (180 minutes). In group II (nonreversed control group); the hearts were stored in Collins' solution throughout 3 hours and were also divided into five subgroups of groups II-a, II-b, II-c, II-d, and II-e in which only a 1-minute flush with Collins' solution was performed at the point corresponding to group I. The coronary flow in any of group II showed a marked decrease during the early reperfusion period. In group I, however, the coronary flow increased significantly in proportion to the duration of the reversing phase. The recovery of the aortic flow and the cardiac output in group I showed a bell-shaped pattern in relation to the duration of the reversing phase, reaching their peak values when reversed for 30 minutes (group I-c). The prolonged reverse (180 minutes) resulted in a deterioration of functional recovery associated with a poorer preservation of high-energy phosphates and a larger enzyme leakage. These results suggest that the beneficial effects of intracellular-type Collins' solution for cold storage of the heart were further improved by reversing Collins' solution with the extracellular-type cardioplegic solution for the last 30 minutes of the 3-hour cold storage because the disadvantageous vasoconstriction due to Collins' solution during reperfusion was successfully prevented by the replacement of intravascular and extravascular Collins' solution with cardioplegic solution before the reperfusion.
(1) 用于心脏冷藏的柯林斯溶液在再灌注期间对心脏有害；(2) 在再灌注前用细胞外型心脏停搏液“逆转”细胞内型柯林斯溶液能够防止柯林斯溶液的这一缺点。制备了以下两个主要组（I组和II组），每组又分为五个亚组（-a至-e）。在I组（逆转组）中，心脏最初储存在柯林斯溶液中，但在3小时总储存的最后1至180分钟内，先用心脏停搏液冲洗1分钟进行逆转，然后储存在心脏停搏液中，即I-a组（逆转1分钟）、I-b组（10分钟）、I-c组（30分钟）、I-d组（90分钟）和I-e组（180分钟）。在II组（未逆转对照组）中，心脏在3小时内一直储存在柯林斯溶液中，也分为II-a、II-b、II-c、II-d和II-e五个亚组，在与I组相对应的时间点仅用柯林斯溶液冲洗1分钟。II组中任何一组在再灌注早期冠状动脉流量均显著下降。然而，在I组中，冠状动脉流量与逆转阶段的持续时间成比例地显著增加。I组中主动脉流量和心输出量的恢复与逆转阶段的持续时间呈钟形模式，在逆转30分钟时（I-c组）达到峰值。长时间逆转（180分钟）导致功能恢复恶化，伴有高能磷酸盐保存较差和酶泄漏增加。这些结果表明，在3小时冷储存的最后30分钟用细胞外型心脏停搏液逆转柯林斯溶液，可进一步改善细胞内型柯林斯溶液对心脏冷藏的有益效果，因为在再灌注前用心脏停搏液替代血管内和血管外的柯林斯溶液，成功防止了再灌注期间柯林斯溶液引起的不利血管收缩。
